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Provisional restorations
John Radford, David Ricketts
CHAPTER CONTENTS
Introduction 177
Characteristics of a provisional restoration 178
Custom-formed resin replica provisional
crowns 179
How to make a custom-formed provisional
restoration 179
Modifications to the technique 181
Establishing the occlusion and aesthetics with
custom-formed provisional restorations 181
Establishing gingival contours with
custom-formed provisional restorations 182
Preformed provisional crowns 183
Provisional polycarbonate crowns 183
Other provisional restorations 183
Provisional replacement of missing teeth 185
Advice during the provisional stage 185
Summary 186
INTRODUCTION
During the time period between tooth preparation and
fit of an indirect restoration it is important in most situa-
tions to provide a patient with a high-quality provisional
restoration. Failure to do so could lead to the early
demise of the definitive restoration for reasons which
will be outlined in this chapter. This comes at great
expense to both patient and dentist, in terms of both
monetary and biological cost, and professional relation-
ship and trust.
Some may argue, why waste precious time crafting a
bespoke provisional restoration only for it to be replaced
within weeks? Moreover, the cynic would argue that
acceptance of the definitive restoration can be problem-
atic if the dental aesthetic and function of the provisional
restoration is comparable to that of the final restoration.
To the contrary, when the dentist appreciates the relation-
ship between form and function of a provisional restora-
tion and its relationship to the immediate and long-term
health of the teeth, supporting structures and the defini-
tive restoration, its importance is unquestioning; the den-
tist/health care professional now only has to acquire the
knowledge and skills to construct one.
Oral health care and treatment planning for advanced
operative procedures follows a logical sequence as out-
lined in the earlier chapters of this textbook: initially sta-
bilizing (including preventing further) dental diseases,
evidence of oral health and then the possible reconstruc-
tion of teeth. The success of each stage of management
depends upon the success of the preceding stage. The
same is true when providing laboratory-fabricated indirect
restorations. It is unacceptable to provide a laboratory-
fabricated restoration without the prior placement of a
provisional restoration. Whilst it is true that a less than
ideal provisional restoration might not always influence
long-term outcome of the definitive restoration, it may
result in a lengthy fit appointment. A health care profes-
sional would not be discharging their responsibility if any
aspect of their treatment is substandard, including the
placement of provisional restorations. The synergy
between an empowered patient, dentist and dental techni-
cian can and should provide a seamless continuum of
dental care and provisional restorations are a part of this.
With respect to terminology, there is a facile debate as
to whether or not such restorations should be called
2011 Elsevier Ltd.
177
provisional or temporary. The debate is perhaps academic
and in this section they will be referred to as provisional
restorations.
CHARACTERISTICS OF
A PROVISIONAL RESTORATION
When considering provisional restorations it is most
logical to consider features that must be achieved and
then other value-added functions of the restoration.
Before exploring these, at the centre of every carers ethic
is Primum nil nocere (First, do no harm). Preparing a
tooth for a laboratory-fabricated restoration will, how-
ever, by necessity: